The Cardiothoracic Anesthesiology Division at the University of Virginia (UVA) provides anesthesia and perioperative care for adult patients undergoing a variety of complex cardiac, thoracic and vascular surgical procedures. Our Division faculty is excited to optimize patient care to give our patients the best possible clinical experience.
Cardiac anesthesiologists routinely perform anesthesia for coronary artery bypass surgery, complex valvular heart disease, thoracic aortic surgery, ventricular assist device placement and heart transplantation. In addition, we care for patients undergoing transcatheter aortic valve replacement (TAVR) and other transcatheter valve procedures as part of the robust Heart Valve Program at UVA. Our Anesthesiology Perioperative Echocardiography Service performs and interprets all adult cardiac surgery transesophageal echocardiography (TEE) and point of care echocardiography in the operating room and in the recovery unit (see Clinical Programs).
Our thoracic anesthesiology team provides comprehensive perioperative care for a wide variety of thoracic procedures, including lung transplantation and surgery of the esophagus, stomach, lungs, mediastinum, and the thoracic spine. Thoracic procedures include open and minimally invasive procedures, including classical video assisted thoracoscopic surgery, as well as robotic surgeries.
Our vascular anesthesiology team administers anesthesia for patients undergoing complex vascular surgery with a patient-centered approach. We have successfully developed and implemented cardiac and thoracic enhanced recovery after surgery (ERAS) programs. We enhance patient care through collaboration among the cardiothoracic and the vascular surgery teams, as well as with nursing staff who are essential to our progress. Teamwork allows us to give our patients the best possible outcomes.
A Message from the Cardiac Division Chief
We have a very talented group of Cardiothoracic Anesthesiologists here at UVA. Our members have wide-ranging interests and skills in education, research, and clinical care. Many members in our division have been the recipients of teaching awards. Research interests are varied and include coagulopathy, echocardiography, advanced monitoring, medical student and resident education, and thoracic anesthesia.
Most of our division members hold National Board of Echocardiography certification in Advanced Perioperative TEE. Our goal is to provide excellent resident education, and several in our division regularly teach cardiothoracic clinical skills in the simulation center and give formal lectures to prepare residents for their cardiac anesthesiology rotation. Many of us also teach transesophageal echocardiography and point-of-care ultrasound (POCUS) to residents through formal lectures as well as hands-on instruction in the simulation center and perioperative setting.
A Message from the Thoracic Division Chief
Thoracic division faculty are exceptionally committed to high quality patient care, education of medical students and residents, and research efforts to improve and advance medical knowledge. Division faculty have extensive expertise in a diverse array of specialized care modalities, including thoracic epidural analgesia, bronchoscopy, advanced airway management techniques, fiberoptic guided placement of lung isolation devices, lung ultrasound, and transesophageal echocardiography.
We are a group of experienced perioperative physicians who are actively engaged in advancing the clinical practice of thoracic anesthesia, teaching the next generation of thoracic anesthesiologists and advancing knowledge through clinical and translational research. Division faculty are involved in education and teaching at the national level and are engaged in collaborative research projects with other leading investigators at home and abroad.
A Message from the Vascular Division Chief
The vascular anesthesia experience at UVA is excellent. The new Aortic Center at UVA brings in many patients with complex aortic disease. With vascular surgery volumes increasing, residents have the opportunity to care for high acuity patients undergoing a variety of vascular procedures, ranging from limb salvage, to dialysis access, to bypass surgeries, to multi-stage hybrid aortic repairs.
Residents are supervised by faculty from many divisions, with dedicated teaching of classic vascular anesthesia principles (preoperative evaluation, the physiology of cross-clamping, spinal drains, coagulation) during high-risk cases. There is an opportunity to hone point-of-care ultrasound (POCUS) technique and non-invasive continuous blood pressure monitoring familiarity during less demanding surgeries. Our division works closely with our vascular surgery colleagues and the rest of the perioperative team to provide the best care possible to all patients undergoing vascular procedures at UVA.
Karen E. Singh, MD
Karen E. Singh, MD, Cardiac Anesthesia Division Chief
Dr. Singh is the Division Chief of Cardiac Anesthesia at the University of Virginia. She specializes in the care of patients undergoing cardiothoracic anesthesia, as well as performing and teaching perioperative TEE and point-of-care cardiac ultrasound. She is interested in improving the care of cardiac surgery patients at UVA, and is involved in ERAS and blood conservation in cardiac surgery. She serves on the ERACS committee, Society of Cardiovascular Anesthesiologists.
John S. McNeil, MD
John McNeil, MD, Vascular Anesthesia Division Chief
Dr. McNeil is a cardiothoracic anesthesiologist at UVA. His interests include coagulation, echocardiography, pulmonary complications, OR efficiency and education. In 2020 he received the Dean’s Excellence in Teaching Award, and he has received several grants related to medical student education.
Read Dr. McNeil’s Full Bio
Link to Dr. McNeil’s Publications
Randal S. Blank, MD, PhD
Randal S. Blank, MD, PhD, Thoracic Anesthesia Division Chief
Dr. Randal S. Blank is a cardiothoracic anesthesiologist who serves as Chief of the Thoracic Division and is the Cosmo A. DiFazio Professor of Anesthesiology in 2019. Dr. Blank works closely with the UVA Division of Thoracic Surgery to improve care and advance the fields of thoracic anesthesia and respiratory medicine. He is currently engaged in clinical research in thoracic anesthesia and respiratory medicine. He is the Associate Editor of the text Principles and Practice of Anesthesia for Thoracic Surgery, serves on numerous professional committees, and was a founding member of the Society of Cardiovascular Anesthesiologists Thoracic Anesthesia Symposium, for which he currently serves as the Chair.
Paul D. Gallo, MD
Paul D. Gallo, MD
Dr. Gallo is a cardiothoracic anesthesiologist and critical care physician. He joined the University of Virginia as an Assistant Professor of Anesthesiology in 2022. Originally from Wisconsin, he received a BSN from Marquette University and a medical degree from Georgetown University. He completed an anesthesiology residency at the University of Wisconsin, and dual fellowship training in critical care and cardiothoracic anesthesiology at Columbia University in New York City.
His professional interests include integrating complex care between the OR and ICU environments, medical education, and interdisciplinary collaboration. Outside of work, he enjoys spending time with his family, running/biking, and cheering on the Green Bay Packers.
Link to Dr. Gallo’s Publications
Amanda M. Kleiman, MD
Amanda M. Kleiman, MD
Dr. Kleiman’s clinical interest/focus centers on caring for patients undergoing cardiothoracic and major vascular surgery, as well as liver transplantation. Her research interests include improvement of the care of cardiothoracic surgical patients, echocardiography, and education research focusing on maximizing the quality of resident and medical student education.
Dr. Kleiman has grant funded research examining sleep disturbance following cardiac surgery and its relationship to delirium and dementia. Her particular education research interests include biases in education, the effect of stress, sleep, and wellness on resident training, and novel education/learning techniques. Outside of work, she enjoys being outside with her friends and golden retriever puppy.
Read Dr. Kleiman’s Full Bio
Link to Dr. Kleiman’s Publications
Keith Littlewood, MD
Keith Littlewood, MD
Dr. Littlewood serves as an Assistant Dean in the School of Medicine and Vice Chair within the Anesthesiology Department. He has been a member of the UVA Faculty since 1999 and is a Fellow of the American Society of Anesthesiology and the Society for Simulation in Healthcare. His research interests include cognitive aspects of clinical decision making and metacognition in healthcare education. He is married to writer Erika Raskin and they have three children and two grandchildren. Keith’s favorite activities include hiking, kayaking, mountain biking, and traveling
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Link to Dr. Littlewood’s Publications
Venkat R. Mangunta, MD
During college, after the September 11th terrorist attack, he decided to join the armed forces and was commissioned as an officer in the US Navy and served five years as an active duty medical officer. He completed a year of General Surgery Training at the University of Missouri School of Medicine at the Naval Medical Center San Diego. He served as a Naval Medical Officer and Naval Flight Surgeon with Marine Attack Squadron 542 from 2009-2012.
After military service Dr. Mangunta completed an Anesthesiology residency at the University of Massachusetts School of Medicine. He completed a Fellowship in Critical Care Medicine at the Johns Hopkins University School of Medicine in Baltimore, and a Fellowship in Cardiovascular Anesthesia at the Baylor College of Medicine/Texas Heart Institute in Houston. He became a Cardiovascular Anesthesiologist and Critical Care Physician at the Saint Luke’s Mid America Heart Institute in Kansas City where he staffed the CVICU and cardiothoracic operating rooms at one of the top 15 busiest heart transplant centers in the nation.
He holds the ABS Certification in Anesthesiology and Critical Care Medicine from the American Board of Anesthesiology. His research interests include: Airborne Infectious Diseases and Isolation Strategies, Cardiogenic Shock and Microvascular Shock, Operative Crew Resource Management (CRM) and Communication, Mechanical Circulatory Support, and VV ECMO for Pulmonary Failure. He joined UVA in August of 2021.
Michael Mazzeffi, MD, MPH, FASA
Michael Mazzeffi, MD, MPH, FASA
Dr. Mazzeffi is a cardiothoracic anesthesiologist and critical care physician. He also serves as the Vice Chair for Faculty Affairs and Development in the department of Anesthesiology. He completed medical school at Tulane University, residency at Mt. Sinai School of Medicine, and his fellowships at Emory University.
He has Master’s degrees in Public Health and Clinical Research and maintains an active research program in perioperative outcomes research and blood coagulation. His research has been funded by the Society of Cardiovascular Anesthesiologists and Anesthesia Patient Safety Foundation. He is an active member of the Society of Cardiovascular Anesthesiologists and is chair of its ECMO committee. He is also a fellow of the American Society of Anesthesiologists.
Outside of work he enjoys running, traveling, fly-fishing, and spending time with family.
Sachin H. Mehta, MD
Sachin H. Mehta, MD
Dr. Mehta was born and raised in central New Jersey, and received a BA in Government from Dartmouth College, graduating summa cum laude. He attended medical school at the University of Pennsylvania, and trained in anesthesiology at the University of California at San Diego. He pursued additional subspecialty training in obstetric anesthesia at Stanford University Medical Center, and cardiac anesthesia at the University of Virginia.
Dr. Mehta serves as Division Chief of Obstetric Anesthesia at the University of Virginia, and as a senior editor on the American Board of Anesthesiology advanced examination committee. He is an Associate Professor of Anesthesiology. His clinical and academic interests include obstetric anesthesia, transesophageal echocardiography, and cardiac anesthesia.
Joshua Roach, MD
Joshua Roach, MD, is board-certified in anesthesiology as well as adult critical care medicine, and completed a fellowship in cardiothoracic anesthesiology in June, 2022. Dr. Roach grew up in West Virginia and earned his medical degree from West Virginia University. He completed residency training in anesthesiology at the University of Virginia, and completed fellowship training in critical care and cardiothoracic anesthesia at The Johns Hopkins School of Medicine in Baltimore.
His professional interests include the neurocognitive and cardiac rehabilitation of patients undergoing transcatheter aortic valve procedures, as well as becoming a leader in the education of tomorrow’s providers. In his spare time, he enjoys running, gardening, hiking, and spending time with his partner and two dogs.
D. Keegan Stombaugh, MD
D. Keegan Stombaugh, MD
Dr. Stombaugh is a cardiothoracic and critical care anesthesiologist at UVA. He specializes in care of patients undergoing cardiac, thoracic, and vascular procedures. In addition, he works as an intensivist in the cardiovascular and thoracic surgical ICU. His primary academic interest is medical education.
Read Dr. Stombaugh’s Full Bio
Link to Dr. Stombaugh’s Publications
Robert H. Thiele, MD
Robert H. Thiele, MD
Dr. Thiele is a cardiac anesthesiologist and intensivist (ICU doctor) at UVA. An engineer by training, he is particularly interested in transesophageal ultrasonography and critical care ultrasound, as well as the use and development of advanced monitoring technology. He also serves as the Division Chief of Critical Care Anesthesiology and is an at-large member of the Board of Directors for the University Physicians Group, in addition to serving on the Finance Committee and Investment Subcommittee.
Read Dr. Thiele’s Full Bio
Link to Dr. Thiele’s Publications
Susan M. Walters, MD
Susan M. Walters, MD
Dr. Walters is from Southern California. She attended medical school at Georgetown University before completing her anesthesiology residency at UVA and a fellowship in cardiothoracic anesthesiology at Emory University. Her interests include management of patients undergoing cardiac and thoracic surgery, echocardiography, medical education, and clinical operations.
We provide anesthesia for approximately 700 cardiopulmonary bypass cases annually at UVA, including CABG, valve repair and replacement, LVADs, ascending aortic surgery, heart and lung transplantation. In addition, we cared for over 300 transcatheter valve patients in the last year. Our team often anesthetizes patients placed on ECMO who require procedures or surgery in the operating room.
We have a robust ERACS (enhanced recovery after cardiac surgery) program, and long-standing practices such as perioperative glucose optimization and targeted transfusion with point-of-care coagulation studies. These have helped us provide excellent patient care over the years. We consistently look for ways to improve patient care and are currently working with a multidisciplinary team in order to optimize blood conservation in cardiac surgery at UVA.
Anesthesiology Perioperative Echocardiography Service
The Anesthesiology Perioperative Echocardiography Service performs and formally interprets transesophageal echo (TEE) for all adult cardiac surgery cases at UVA. The service also provides point of
care transthoracic and transesophageal exams for hemodynamically unstable patients in the operating room and in the post-anesthesia recovery unit. All covering faculty are certified by the National Board of Echocardiography in Advanced Perioperative TEE. This service is an excellent format for formal TEE and POCUS teaching for residents on their TEE rotation.
Members of the thoracic anesthesia team provide care for patients planning and undergoing complex and high risk procedures including lung transplantation, esophagectomy, complex resections of the lung and major conducting airways, tracheobronchial resection and reconstruction, high risk mediastinal mass resection and chest trauma. Our team collaborates closely with thoracic surgeons and other interventionalists to plan complex cases and optimize the perioperative patient experience. We are committed to the highest level of care throughout the perioperative process and have pioneered an enhanced recovery program (ERP) for thoracic surgery which has reduced hospital stay and costs while dramatically reducing opioid utilization in both the short and long term. We review the ERP quarterly in an ongoing effort to optimize the program, incorporating advances in the field. This ERP has served as the model for similar programs at other leading institutions.
Our division cares for patients undergoing many types of major vascular surgery. Last year UVA performed approximately 230 major open and endovascular aortic cases. Complex endovascular procedures are increasing in number. Currently, our division is working with a multidisciplinary team to create an ERAS pathway for open abdominal aortic surgery cases.
Current Clinical Research Projects
Robert Thiele, MD
We study the use of near infrared spectroscopy (NIRS) to measure the oxidation state of cytochrome aa3, the terminal component of the electron transport chain. Our ultimate goal is to detect brain ischemia at the level of the tissue itself, rather than relying on hemoglobin oxygenation which is really only a surrogate marker. Our initial work utilized “broadband NIRS” but we have shifted towards more sophisticated time-domain and frequency-domain techniques that rely on laser light sources. This work is led by Dr. Robert Thiele, was originally funded by the Society of Cardiovascular Anesthesiologists and is now funded by the NIH (National Institute of Biomedical Imaging and Bioengineering).
John McNeil, MD
We are involved in a multi-center randomized controlled trial looking at the safety and efficacy of a novel red blood cell washing technique in cardiac surgery
Randal S. Blank, M.D., Ph.D.
We are currently engaged in a number of research efforts in various subfields of thoracic anesthesia and respiratory medicine. These include the impact of one lung ventilation management on postoperative outcomes, management of mediastinal mass syndrome, the role of driving pressure in the development of postoperative pulmonary complications, the effects of alveolar hyperoxia and systemic hyperoxemia on postoperative complications, mechanical power delivery to the respiratory system, and geospatial factors and pulmonary complications after lung resection surgery
Stombaugh DK, Daubenspeck D, Chaney MA, Lu S, Fitzsimons MG, Gerlach RM. “Percutaneous Vacuum-Assisted Thrombectomy for Right Atrial Mass.” J Cardiothorac Vasc Anesth. 2021 Dec 18:S1053-0770(21)01098-3.doi:10.1053/j.jvca.2021.12.015. Online ahead of print. PMID: 35094924 No abstract available.
Spencer C, Heller S, Singh K. “Incidental TEE finding of aberrant chordae tendineae insertion into the basal septum.” Echocardiography. 2022 Jan;39(1):101-103. doi:10.1111/echo.15202. Epub 2021 Dec 5. PMID: 34866243.
Hartigan PM, Karamnov S, Gill RR, Ng JM, Yacoubian S, Tsukada H, Swanson J, Barlow J, McMurry TL, Blank RS. “Mediastinal Masses, Anesthetic Interventions, and Airway Compression in Adults: A Prospective Observational Study.” Anesthesiology. 2022 Jan 1;136(1):104-114.doi:10.1097/ALN.000000000000411.PMID:34724550.
McNeil JS, Raphael J. “There May Not Be a Definite Winner, But Fibrinogen Concentrate is Clearly a Factor to Be Reckoned With.” Anesth Analg. 2021 Jul 1;133(1):16-18. doi: 10.1213/ANE.0000000000005566.
PMID: 34127585 No abstract available.
Esfahani K, Bunker BA, Heller SJ, O’Connor EG, Walters SM, Kleiman AM. “Anesthetic Considerations for Endovascular Neurologic, Vascular, and Cardiac Procedures.” Adv Anesth. 2020 Dec;38:63-95. doi: 10.1016/j.aan.2020.07.004. Epub 2020 Sep 18. PMID: 34106841 Review. No abstract available.
Thiele RH, Theodore DJ, Gan TJ. “Outcome of Organ Dysfunction in the Perioperative Period.” Anesth Analg. 2021 Aug 1;133(2):393-405. doi:10.1213/ANE.0000000000005603. PMID: 34081049 Review.
Stombaugh DK, Thomas C, Dalton A, Chaney MA, Nunnally ME, Berends AMA, Kerstens MN. “Pheochromocytoma Resection in a Patient With Chronic Thromboembolic Pulmonary Hypertension and Thrombocytopenia.” J Cardiothorac Vasc Anesth. 2021 Nov;35(11):3423-3433.doi:10.1053/j.jvca.2021.03.034. Epub 2021 Mar 26. PMID: 33931343 No abstract available.
Colquhoun DA, Leis AM, Shanks AM, Mathis MR, Naik BI, Durieux ME, Kheterpal S, Pace NL, Popescu WM, Schonberger RB, Kozower BD, Walters DM, Blasberg JD, Chang AC, Aziz MF, Harukuni I, Tieu BH, Blank RS. “A Lower Tidal Volume Regimen during One-lung Ventilation for Lung Resection Surgery Is Not Associated with Reduced Postoperative Pulmonary Complications.” Anesthesiology. 2021 Apr 1;134(4):562-576.doi:10.1097/ALN.000000000000329. PMID: 33635945.
Misra S, Behera BK, Preetam C, Mohanty S, Mahapatra RP, Tapuria P, Elayat A, Nayak A, Kotkar K, McNeil JS, Blank RS. “Peripheral Cardiopulmonary Bypass in Two Patients With Symptomatic Tracheal Masses: Perioperative Challenges.” J Cardiothorac Vasc Anesth. 2021 May;35(5):1524-1533. doi: 10.1053/j.jvca.2020.11.041. Epub 2020 Nov 25. PMID: 33339662.
Thiele RH, Shaw AD, Bartels K, Brown CH 4th, Grocott H, Heringlake M, Gan TJ, Miller TE, McEvoy MD; Perioperative Quality Initiative (POQI) 6 Workgroup. “American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on the Role of Neuromonitoring in Perioperative Outcomes: Cerebral Near-Infrared Spectroscopy.” Anesth Analg. 2020 Nov;131(5):1444-1455.doi:10.1213/ANE.0000000000005081. PMID: 33079868 Review.
Manson WC, Blank RS, Martin LW, Alpert SB, Dobrzanski TP, Schneider EB, Ratcliffe SJ, Durieux ME. “An Observational Study of the Pharmacokinetics of Surgeon-Performed Intercostal Nerve Blockade With Liposomal Bupivacaine for Posterior-Lateral Thoracotomy Analgesia.” Anesth Analg. 2020 Dec;131(6):1843-1849. doi:10.1213/ANE.0000000000005115. PMID: 32833710.
Saugel B, Thiele RH, Hapfelmeier A, Cannesson M. “Technological Assessment and Objective Evaluation of Minimally Invasive and Noninvasive Cardiac Output Monitoring Systems.” Anesthesiology. 2020 Oct 1;133(4):921-928. doi:10.1097/ALN.0000000000003483. PMID: 32773696 Free PMC article. Review.
Haywood N, Nickel I, Zhang A, Byler M, Scott E, Julliard W, Blank RS, Martin LW. “Enhanced Recovery After Thoracic Surgery.” Thorac Surg Clin. 2020 Aug;30(3):259-267. doi: 10.1016/j.thorsurg.2020.04.005. Epub 2020 Apr 17. PMID: 32593359 Review.
Whalen LB, Davies SW, Singh K, Ailawadi G. “Epicardial ultrasound in a case of myocardial bridge and apical hypertrophic cardiomyopathy.” J Card Surg. 2020 Aug;35(8):2041-2043. doi: 10.1111/jocs.14627. Epub 2020 Jun 19. PMID: 32557779.
Moon YJ, Bechtel AJ, Kim SH, Kim JW, Thiele RH, Blank RS. “Detection of intratracheal accumulation of thick secretions by using continuous monitoring of respiratory acoustic spectrum: a preliminary analysis.” J Clin Monit Comput. 2020 Aug;34(4):763-770. doi:10.1007/s10877-019-00359-z. Epub 2019 Jul 20. PMID: 31327100.
Johnston LE, Thiele RH, Hawkins RB, Downs EA, Jaeger JM, Brooks C, Ghanta RK, Ailawadi G, Kron IL, Isbell JM; Virginia Interdisciplinary Cardiothoracic Outcomes Research Center. “Goal-directed resuscitation following cardiac surgery reduces acute kidney injury: A quality initiative pre-post analysis.” J Thorac Cardiovasc Surg. 2020 May;159(5):1868-1877.e1. doi: 10.1016/j.jtcvs.2019.03.135. Epub 2019 May 17. PMID: 31272751.
Education and Training
Our residents care for the vast majority of cardiac, thoracic, and major vascular cases at UVA. Residents are assigned at least 3.5 months of cardiac, one month of thoracic, and 2 weeks of vascular rotations throughout their residency; in addition, they are often assigned these types of cases on general OR rotations. Prior to their first week on the cardiac rotation, they complete a preparation week involving observation and involvement in cardiac cases, as well as simulation and teaching sessions in the Simulation Center.
A main focus of our division is performing and teaching TEE and focused cardiac ultrasound. Residents rotate through 2-4 weeks of TEE rotation in the operating room where they learn the basics of TEE in cardiac surgery patients, and we frequently incorporate focused transthoracic echocardiography in the perioperative care of noncardiac surgery patients. Additionally, residents train in procedures required for non cardiac thoracic surgery, including regional and neuraxial analgesic techniques, fiberoptic bronchoscopy, advanced airway management techniques, lung isolation and one lung ventilation and lung ultrasound. Outside of the operating room, members of our division are involved in teaching a monthly Perioperative Ultrasound Course lecture or hands-on workshop, and residents are taught point-of-care ultrasound (POCUS) in the simulation center by several faculty in our group during their days set aside for education.